Sample page. Laboratory. Cross Coder. Essential links from CPT codes to ICD-10-CM and HCPCS

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1 Cross Coder 2018 Laboratory Essential links from CPT codes to ICD-10-CM and HCPCS POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.

2 Contents Introduction...i Organ or Disease-Oriented Panels...1 Immunology Transfusion Medicine Drug Assay...13 Drug Testing...22 Therapeutic Drug Assays...49 Evocative/Suppression Testing...54 Urinalysis...61 Molecular Pathology...62 Chemistry...87 Hematology and Coagulation Microbiology Anatomic Pathology Cytopathology Cytogenetic Studies Surgical Pathology Other Procedures Reproductive Medicine Procedures Optum360, LLC 2017 American Medical Association. All Rights Reserved. i

3 Introduction Optum360 is pleased to present the 2017 Laboratory Cross Coder. Fully comprehensive, Laboratory Cross Coder links most CPT laboratory codes to corresponding ICD-10-CM diagnosis and HCPCS Level II codes. Optum360 believes that professional coders working in laboratories, physician s offices, clinical outpatient areas, hospitals, as well as payer settings will embrace this reference. Laboratory Cross Coder is based on the Pathology and Laboratory section of the Current Procedural Terminology (CPT). Up-to-date CPT laboratory codes link to the following related medical coding systems: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Healthcare Common Procedural Coding System (HCPCS) Level II All coding relationships in Laboratory Cross Coder spring from CPT s pathology and laboratory codes and the term CPT-driven is sometimes heard. But it is perhaps more appropriate to think of this reference book as data driven. A team of clinical and coding experts launched Laboratory Cross Coder by first reviewing data drawn from the Optum360 information base of nationwide medical claims. Pertinent laboratory-related coding relationships were drawn from the data stream and processed for coding errors and other anomalies. From this early cut of data emerged a general clinical picture of each laboratory code, but data analysis for Laboratory Cross Coder had hardly begun. Some CPT codes are omitted from the listing because consistent and reliable cross-links are almost impossible to establish. Unlisted procedure codes are an obvious example. Certain types of add-on codes are also treated somewhat differently in Laboratory Cross Coder. These codes are discussed in greater detail under the CPT Codes section later in this Introduction. As a data-driven coding reference, Laboratory Cross Coder presents most likely scenarios as derived from clinical information sources. However, Laboratory Cross Coder is not a substitute for ICD-10-CM or any other medical coding reference and users are urged to regularly consult all available sources. The absence of any specific code does not necessarily indicate that its association to the base procedure code is inappropriate. Assuming all rules of laboratory coding are followed, excepted diagnosis codes may prove appropriate to a specific code scenario. Laboratory Cross Coder does not include coding rules or guidelines. Once again, the user is urged to consult the original coding reference (e.g., CPT, ICD-10-CM, HCPCS Level II, etc.) or one of several reputable medical coding instruction manuals. Format An understanding of the Laboratory Cross Coder format allows users to easily navigate its content. Information within the main section ties to the CPT book and the codes are presented in the same numeric order as the pathology and laboratory section. Sections Laboratory Cross Coder provides linked information to the CPT code range to The codes are divided into the same sections as the Pathology and Laboratory section of the CPT book. Codes and Code Ranges The data within each CPT code set of Laboratory Cross Coder is presented as follows: CPT code or code range CPT codes and descriptions ICD-10-CM diagnostic codes and descriptions HCPCS Level II codes and descriptions For example: MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis, common variants (eg, IVS3-2A>G, del6.4kb) E75.11 Mucolipidosis IV Z13.71 Encounter for nonprocreative screening for genetic disease carrier status Z13.79 Encounter for other screening for genetic and chromosomal anomalies Z31.5 Encounter for genetic counseling HCPCS Level II Supplies & Services G0452 Molecular pathology procedure; physician interpretation and report Each CPT code or code range is followed by its specific ICD-10-CM and HCPCS Level II links. Laboratory Cross Coder presents full descriptions for all CPT codes and their links. National Coverage Decisions Your Laboratory Cross Coder also indicates when a service is subject to a National Coverage Decision (NCD) by placing NCD after the code. An NCD for a diagnostic laboratory test is a national policy statement granting, limiting, or excluding Medicare coverage for that test. An NCD will indicate Medicare policy regarding the circumstances under which the test will be considered reasonable and necessary. This is important because Medicare will not provide coverage for a service that is not medically necessary such as tests for screening purposes only or otherwise not indicated by the patient s diagnosis. NCDs are applicable nationwide and must be adhered to by all Medicare contractors including fiscal intermediaries and carriers. Each of the clinical diagnostic laboratory service NCDs contain lists of CPT codes identifying the service, indications and limitations of coverage, and ICD-10-CM codes that support the medical necessity of the procedure. Also included, when applicable, are any documentation requirements that may be necessary. NCDs are periodically updated so it is important that they be reviewed on a regular basis. The complete national coverage decisions may be found at: Other Payers Non-governmental payers may follow the Medicare NCDs or they may develop their own policies on coverage of laboratory tests, either routine or advanced diagnostic testing. Always check with the insurance company for coverage criteria. Many may have on-line policies that can be reviewed Optum360, LLC 2017 American Medical Association. All Rights Reserved. i

4 Laboratory Cross Coder NCD Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) B15.0 B15.9 B16.0 B16.1 B16.2 B16.9 B17.0 B17.10 B17.11 B17.2 B17.8 B18.0 B18.1 B18.2 B18.8 G93.3 I85.00 I85.01 I85.10 I85.11 K70.41 K71.0 K71.10 K71.11 K71.2 K71.3 K71.4 K71.50 K71.51 K71.6 K71.7 K71.8 K72.00 K72.01 K72.10 K72.11 K74.0 K74.69 K75.0 K75.1 K75.2 K75.3 K75.81 K75.89 K76.2 K76.4 K76.6 K76.7 K76.81 R10.0 R10.11 R10.12 R10.13 R10.2 R10.31 R10.32 R10.33 R R Hepatitis A with hepatic coma Hepatitis A without hepatic coma Acute hepatitis B with delta-agent with hepatic coma Acute hepatitis B with delta-agent without hepatic coma Acute hepatitis B without delta-agent with hepatic coma Acute hepatitis B without delta-agent and without hepatic coma Acute delta-(super) infection of hepatitis B carrier Acute hepatitis C without hepatic coma Acute hepatitis C with hepatic coma Acute hepatitis E Other specified acute viral hepatitis Chronic viral hepatitis B with delta-agent Chronic viral hepatitis B without delta-agent Chronic viral hepatitis C Other chronic viral hepatitis Postviral fatigue syndrome Esophageal varices without bleeding Esophageal varices with bleeding Secondary esophageal varices without bleeding Secondary esophageal varices with bleeding Alcoholic hepatic failure with coma Toxic liver disease with cholestasis Toxic liver disease with hepatic necrosis, without coma Toxic liver disease with hepatic necrosis, with coma Toxic liver disease with acute hepatitis Toxic liver disease with chronic persistent hepatitis Toxic liver disease with chronic lobular hepatitis Toxic liver disease with chronic active hepatitis without ascites Toxic liver disease with chronic active hepatitis with ascites Toxic liver disease with hepatitis, not elsewhere classified Toxic liver disease with fibrosis and cirrhosis of liver Toxic liver disease with other disorders of liver Acute and subacute hepatic failure without coma Acute and subacute hepatic failure with coma Chronic hepatic failure without coma Chronic hepatic failure with coma Hepatic fibrosis Other cirrhosis of liver Abscess of liver Phlebitis of portal vein Nonspecific reactive hepatitis Granulomatous hepatitis, not elsewhere classified Nonalcoholic steatohepatitis (NASH) Other specified inflammatory liver diseases Central hemorrhagic necrosis of liver Peliosis hepatis Portal hypertension Hepatorenal syndrome Hepatopulmonary syndrome Acute abdomen Right upper quadrant pain Left upper quadrant pain Epigastric pain Pelvic and perineal pain Right lower quadrant pain Left lower quadrant pain Periumbilical pain Right upper quadrant abdominal tenderness Right upper quadrant rebound abdominal tenderness R10.83 R10.84 R11.0 R11.11 R11.12 R11.14 R16.0 R16.2 R53.0 R53.1 R53.2 R53.81 R53.83 R56.00 R56.01 R56.1 R62.0 R62.51 R62.52 R62.59 R63.0 R63.1 R63.2 R63.3 R63.4 R63.5 R63.6 R74.0 R94.5 T86.41 T86.42 T86.43 T86.49 Z01.89 Colic Generalized abdominal pain Nausea Vomiting without nausea Projectile vomiting Bilious vomiting Hepatomegaly, not elsewhere classified Hepatomegaly with splenomegaly, not elsewhere classified Neoplastic (malignant) related fatigue Weakness Functional quadriplegia Other malaise Other fatigue Simple febrile convulsions Complex febrile convulsions Post traumatic seizures Delayed milestone in childhood Failure to thrive (child) Short stature (child) Other lack of expected normal physiological development in childhood Anorexia Polydipsia Polyphagia Feeding difficulties Abnormal weight loss Abnormal weight gain Underweight Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH] Abnormal results of liver function studies Liver transplant rejection Liver transplant failure Liver transplant infection Other complications of liver transplant Encounter for other specified special examinations HCPCS Level II Supplies & Services P9603 P9604 Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated miles actually travelled Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated trip charge Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) A06.4 A52.74 B15.0 B15.9 B16.0 B16.1 B16.2 B16.9 B17.0 B17.10 B17.11 B17.2 Amebic liver abscess Syphilis of liver and other viscera Hepatitis A with hepatic coma Hepatitis A without hepatic coma Acute hepatitis B with delta-agent with hepatic coma Acute hepatitis B with delta-agent without hepatic coma Acute hepatitis B without delta-agent with hepatic coma Acute hepatitis B without delta-agent and without hepatic coma Acute delta-(super) infection of hepatitis B carrier Acute hepatitis C without hepatic coma Acute hepatitis C with hepatic coma Acute hepatitis E 2017 Optum360, LLC NCD National Coverage Decision CPT 2017 American Medical Association. All Rights Reserved. [Resequenced code] ; Female diagnosis : Male diagnosis 11

5 Chemistry Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative quantitative E09.10 E10.10 E10.11 E E13.10 E13.11 F Drug or chemical induced diabetes mellitus with ketoacidosis without coma Type 1 diabetes mellitus with ketoacidosis without coma Type 1 diabetes mellitus with ketoacidosis with coma Type 1 diabetes mellitus with hypoglycemia with coma Other specified diabetes mellitus with ketoacidosis without coma Other specified diabetes mellitus with ketoacidosis with coma Alcohol abuse with intoxication, uncomplicated Acetylcholinesterase D Sickle-cell thalassemia with acute chest syndrome D Sickle-cell thalassemia with splenic sequestration D58.0 Hereditary spherocytosis D64.4 Congenital dyserythropoietic anemia D64.89 Other specified anemias T44.0X1A Poisoning by anticholinesterase agents, accidental (unintentional), initial T44.0X2A Poisoning by anticholinesterase agents, intentional self-harm, initial T44.0X3A Poisoning by anticholinesterase agents, assault, initial T44.0X4A Poisoning by anticholinesterase agents, undetermined, initial T44.1X1A Poisoning by other parasympathomimetics [cholinergics], accidental (unintentional), initial T44.1X2A Poisoning by other parasympathomimetics [cholinergics], intentional self-harm, initial T44.1X3A Poisoning by other parasympathomimetics [cholinergics], assault, initial T44.1X4A Poisoning by other parasympathomimetics [cholinergics], undetermined, initial Acylcarnitines; qualitative, each specimen quantitative, each specimen E E E E E E E71.32 E71.41 E71.42 Long chain/very long chain acyl CoA dehydrogenase deficiency Medium chain acyl CoA dehydrogenase deficiency Short chain acyl CoA dehydrogenase deficiency Glutaric aciduria type II Muscle carnitine palmitoyltransferase deficiency Other disorders of fatty-acid oxidation Disorders of ketone metabolism Primary carnitine deficiency Carnitine deficiency due to inborn errors of metabolism E71.43 E E Iatrogenic carnitine deficiency Ruvalcaba-Myhre-Smith syndrome Other secondary carnitine deficiency Adrenocorticotropic hormone (ACTH) Adenosine, 5-monophosphate, cyclic (cyclic AMP) C74.01 C74.02 C74.11 C74.12 E05.00 E05.01 E21.0 E21.1 E21.2 E22.0 E23.0 E23.1 E24.0 E24.2 E24.3 E24.4 E24.8 E25.0 E25.8 E27.0 E27.1 E27.2 E27.3 E27.49 E89.3 E89.6 F32.0 F32.1 F32.2 F32.3 F32.4 Malignant neoplasm of cortex of right adrenal gland Malignant neoplasm of cortex of left adrenal gland Malignant neoplasm of medulla of right adrenal gland Malignant neoplasm of medulla of left adrenal gland Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm Primary hyperparathyroidism Secondary hyperparathyroidism, not elsewhere classified Other hyperparathyroidism Acromegaly and pituitary gigantism Hypopituitarism Drug-induced hypopituitarism Pituitary-dependent Cushing's disease Drug-induced Cushing's syndrome Ectopic ACTH syndrome Alcohol-induced pseudo-cushing's syndrome Other Cushing's syndrome Congenital adrenogenital disorders associated with enzyme deficiency Other adrenogenital disorders Other adrenocortical overactivity Primary adrenocortical insufficiency Addisonian crisis Drug-induced adrenocortical insufficiency Other adrenocortical insufficiency Postprocedural hypopituitarism Postprocedural adrenocortical (-medullary) hypofunction Major depressive disorder, single episode, mild Major depressive disorder, single episode, moderate Major depressive disorder, single episode, severe without psychotic features Major depressive disorder, single episode, severe with psychotic features Major depressive disorder, single episode, in partial remission Albumin; serum, plasma or whole blood urine or other source, quantitative, each specimen urine, microalbumin, quantitative B52.0 C88.8 E09.21 E09.22 E09.29 Plasmodium malariae malaria with nephropathy Other malignant immunoproliferative diseases Drug or chemical induced diabetes mellitus with diabetic nephropathy Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease Drug or chemical induced diabetes mellitus with other diabetic kidney complication 2017 Optum360, LLC NCD National Coverage Decision CPT 2017 American Medical Association. All Rights Reserved. [Resequenced code] ; Female diagnosis : Male diagnosis 87